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91_HB4610
LRB9112338DJpc
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 5-5.4 and repealing Article V-E.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Section 5-5.4 as follows:
7 (305 ILCS 5/5-5.4) (from Ch. 23, par. 5-5.4)
8 Sec. 5-5.4. Standards of Payment - Department of Public
9 Aid. The Department of Public Aid shall develop standards of
10 payment of skilled nursing and intermediate care services in
11 facilities providing such services under this Article which:
12 (1) Provides for the determination of a facility's
13 payment for skilled nursing and intermediate care services on
14 a prospective basis. The amount of the payment rate for all
15 nursing facilities certified under the medical assistance
16 program shall be prospectively established annually on the
17 basis of historical, financial, and statistical data
18 reflecting actual costs from prior years, which shall be
19 applied to the current rate year and updated for inflation,
20 except that the capital cost element for newly constructed
21 facilities shall be based upon projected budgets. The
22 annually established payment rate shall take effect on July 1
23 in 1984 and subsequent years. Rate increases shall be
24 provided annually thereafter on July 1 in 1984 and on each
25 subsequent July 1 in the following years, except that no rate
26 increase and no update for inflation shall be provided on or
27 after July 1, 1994 and before July 1, 2000, unless
28 specifically provided for in this Section.
29 For facilities licensed by the Department of Public
30 Health under the Nursing Home Care Act as Intermediate Care
31 for the Developmentally Disabled facilities or Long Term Care
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1 for Under Age 22 facilities, the rates taking effect on July
2 1, 1998 shall include an increase of 3%. For facilities
3 licensed by the Department of Public Health under the Nursing
4 Home Care Act as Skilled Nursing facilities or Intermediate
5 Care facilities, the rates taking effect on July 1, 1998
6 shall include an increase of 3% plus $1.10 per resident-day,
7 as defined by the Department.
8 For facilities licensed by the Department of Public
9 Health under the Nursing Home Care Act as Intermediate Care
10 for the Developmentally Disabled facilities or Long Term Care
11 for Under Age 22 facilities, the rates taking effect on July
12 1, 1999 shall include an increase of 1.6% plus $3.00 per
13 resident-day, as defined by the Department. For facilities
14 licensed by the Department of Public Health under the Nursing
15 Home Care Act as Skilled Nursing facilities or Intermediate
16 Care facilities, the rates taking effect on July 1, 1999
17 shall include an increase of 1.6% and, for services provided
18 on or after October 1, 1999, shall be increased by $4.00 per
19 resident-day, as defined by the Department.
20 Rates established effective each July 1 shall govern
21 payment for services rendered throughout that fiscal year,
22 except that rates established on July 1, 1996 shall be
23 increased by 6.8% for services provided on or after January
24 1, 1997, and except that for those facilities with rates less
25 than the actual, audited costs, rates established on July 1,
26 2000 shall be increased to no less than the lower of the
27 average costs in the facility's geographic area as defined by
28 the Department or the facility's actual audited, adjusted
29 costs. In no case shall a facility's July 1, 2000 rate be
30 less than its July 1, 1999 rate. The repeal of Article V-E
31 by this amendatory Act of the 91st General Assembly shall
32 have no effect on the rates paid to facilities. Such rates
33 will be based upon the rates calculated for the year
34 beginning July 1, 1990, and for subsequent years thereafter
-3- LRB9112338DJpc
1 shall be based on the facility cost reports for the facility
2 fiscal year ending at any point in time during the previous
3 calendar year, updated to the midpoint of the rate year. The
4 cost report shall be on file with the Department no later
5 than April 1 of the current rate year. Should the cost
6 report not be on file by April 1, the Department shall base
7 the rate on the latest cost report filed by each skilled care
8 facility and intermediate care facility, updated to the
9 midpoint of the current rate year. In determining rates for
10 services rendered on and after July 1, 1985, fixed time shall
11 not be computed at less than zero. The Department shall not
12 make any alterations of regulations which would reduce any
13 component of the Medicaid rate to a level below what that
14 component would have been utilizing in the rate effective on
15 July 1, 1984.
16 (2) Shall take into account the actual costs incurred by
17 facilities in providing services for recipients of skilled
18 nursing and intermediate care services under the medical
19 assistance program.
20 (3) Shall take into account the medical and
21 psycho-social characteristics and needs of the patients.
22 (4) Shall take into account the actual costs incurred by
23 facilities in meeting licensing and certification standards
24 imposed and prescribed by the State of Illinois, any of its
25 political subdivisions or municipalities and by the United
26 States Department of Health, Education and Welfare pursuant
27 to Title XIX of the Social Security Act.
28 The Department of Public Aid shall develop precise
29 standards for payments to reimburse nursing facilities for
30 any utilization of appropriate rehabilitative personnel for
31 the provision of rehabilitative services which is authorized
32 by federal regulations, including reimbursement for services
33 provided by qualified therapists or qualified assistants, and
34 which is in accordance with accepted professional practices.
-4- LRB9112338DJpc
1 Reimbursement also may be made for utilization of other
2 supportive personnel under appropriate supervision.
3 (Source: P.A. 90-9, eff. 7-1-97; 90-588, eff. 7-1-98; 91-24,
4 eff. 7-1-99.)
5 (305 ILCS 5/Art. V-E rep.)
6 Section 6. The Illinois Public Aid Code is amended by
7 repealing Article V-E.
8 Section 99. Effective date. This Act takes effect upon
9 becoming law.